Palmar erythema in liver failure is due to:

Ans. (d) EstrogenRef: Harrison 18th edition, chapter 311* The hyperdynamic circulatory state of portal hypertension is associated with a dilated, vascular periphery. This is driven by an excess of systemic nitric oxide and estrogen.* When these telangectasias occur in the palms, it frequently manifests as a diffuse Palmar erythema and the individual vessels are not clearly demarcated.* This is because the skin on the thenar and hypothenar prominences is thicker and the ectatic vessels are deeper within the dermis.* Ectatic blood vessels commonly form, and are often noted atop the chest, neck and face. These are referred to as 'spider telangectasias because they fill centrifugally (like legs of a spider) after the center is blanched.* Palmar erythema can also be seen in pregnancy, polycythemia, thyrotoxicosis, rheumatoid arthritis, excema, psoriasis and even normal individualsSigns of Liver Cell Failure1. The liver and spleen may be enlarged, with the liver edge being firm and nodular2. Scleral icterus3. Palmar erythema4. Spider angiomas5. Parotid gland enlargement6. Digital clubbing7. Muscle wasting, or the development of edema and ascites.8. Men may have decreased body hair and gynecomastia as well as testicular atrophy, which may be a consequence of hormonal abnormalities or a direct toxic effect of alcohol on the testes.9. In women with advanced alcoholic cirrhosis, menstrual irregularities usually occur, and some women may be amenorrheic.